Individual provider Active NPI

Jerome William Larson, M.D.

  • Vascular & Interventional Radiology Physician
  • Tulsa, OK
National Provider Identifier
1902242654
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
35610 Issued in OK
Practice address
5801 E 41St St Ste 900
Tulsa, OK 74135-5631
Phone
(918) 747-4975
Fax
(918) 743-8552
NPI assigned
May 21, 2013
Last updated
Sep 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 35610 OK
Vascular & Interventional Radiology Physician 2085R0204X W8187 TX
General Practice Physician 208D00000X A162079 CA
Vascular & Interventional Radiology Physician 2085R0204X 35610 OK Primary
Surgery Physician 208600000X 125062965 IL
Diagnostic Radiology Physician 2085R0202X ME183938 FL

Addresses

Primary practice location

5801 E 41St St Ste 900
Tulsa, OK 74135-5631

Mailing address

PO Box 4930
Tulsa, OK 74159-0930
Phone (918) 747-4975

Other practice location 1

4250 Hospital Dr
Marianna, FL 32446-1917
Phone (850) 526-2200

Other practice location 2

1983 Marengo St
Los Angeles, CA 90033-1370
Phone (323) 409-7677

Other practice location 3

1653 W. Congress Parkway
Rush University Medical Center
Chicago, IL 60612
Phone (405) 397-0376

Other practice location 4

2101 Pease St
Harlingen, TX 78550-8307
Phone (956) 389-6565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200515000419 OK Practitioner - Diagnostic Radiology 0042641656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Oklahoma College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Consultants of Tulsa, Inc.Group PAC ID 0648269324, 34 clinicians

Practice addresses (Care Compare)

5801 E 41St St
Suite 900
Tulsa, OK 74135-5631
Phone (918) 743-8838

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.65 of 100Reported as group
Quality
92.54
Improvement activities
40
Cost
39.2

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35610OKMDVascular & Interventional Radiology Physician
125062965ILMDSurgery Physician
A162079CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Consultants of Tulsa Inc Diagnostic Radiology CurrentSince Jul 1, 2020 Accepting new patients

Locations

5801 E 41st St
Ste 900
Tulsa, OK 74135
Phone (918) 743-8838

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789948800000",
    "number": "1902242654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4930",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741590930",
            "telephone_number": "918-747-4975",
            "fax_number": "918-743-8552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 E 41ST ST STE 900",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741355631",
            "telephone_number": "918-747-4975",
            "fax_number": "918-743-8552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4250 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Marianna",
            "state": "FL",
            "postal_code": "324461917",
            "country_code": "US",
            "telephone_number": "850-526-2200",
            "fax_number": "850-718-2844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1983 Marengo St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900331370",
            "country_code": "US",
            "telephone_number": "323-409-7677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1653 W. Congress Parkway",
            "address_2": "Rush University Medical Center",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60612",
            "country_code": "US",
            "telephone_number": "405-397-0376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2101 Pease St",
            "address_purpose": "LOCATION",
            "city": "Harlingen",
            "state": "TX",
            "postal_code": "785508307",
            "country_code": "US",
            "telephone_number": "956-389-6565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JEROME",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-21",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "35610",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "W8187",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A162079",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OK",
            "license": "35610",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125062965",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME183938",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.